Written evidence submitted by the British Heart Foundation Northern Ireland (BHF NI), relating to the funding and delivery of public services in Northern Ireland inquiry (FPC0025)
We raise money to fund research into heart and circulatory diseases and their risk factors.
The British Heart Foundation (BHF) is the largest independent funder of cardiovascular research in the UK. We are the biggest independent funder of heart and circulatory research in Northern Ireland, having invested nearly £10 million.
We have been funding science since 1961. In that time, the annual number of deaths from heart and circulatory diseases in the UK has fallen by half. But 1 in 4 people in Northern Ireland still die from heart and circulatory diseases.
We continue to work towards a world free from the fear of heart and circulatory diseases.
We welcome the Committee’s inquiry and would be willing to meet with members to discuss our submission in more detail.
Non-communicable diseases (NCDs) such as heart disease, cancer, stroke, diabetes, lung disease and liver disease are some of the leading causes of death and ill-health in Northern Ireland. Together with eight other local health organisations, the British Heart Foundation Northern Ireland (BHF NI) is calling for urgent, population-level action to address modifiable and societal risk factors – such as reducing rates of smoking, harmful alcohol consumption, and overweight and obesity - tackle NCDs and prevent many of these deaths and lost years of healthy life.
Public awareness and health promotion campaigns are a key mechanism with which to raise these issues with the public. NCDs disproportionately affect the most deprived in our communities and play a substantial role in widening health inequalities. Appropriately funded health promotion campaigns and services that reach these communities are vital to reduce preventable death and ill- health from smoking, harmful alcohol consumption, and overweight and obesity.
The Department of Health’s budget briefing published in March 2023 outlined the financial pressure that the Department is under. Per capita spending on health in Northern Ireland fell below England for the first time in 2022/23 based on the Draft Budget.
This is within a context where it is generally accepted that Northern Ireland has a greater need and therefore spending needs to be higher in order to provide the same level of services for people in Northern Ireland as the rest of the UK.
The Department of Health has stated that in the absence of significant additional funding, health trusts will be required to make cuts that will be counter-strategic to long term service sustainability. In describing the impacts of this budget, the Department has stated that reductions in health promotion may be implemented as a ‘lower impact saving’. However, ill-health and disability caused by tobacco, alcohol and overweight and obesity, already places enormous demands on Health and Social Care (HSC), and cuts to the health promotion budget will have a detrimental impact on the prevalence of NCDs in Northern Ireland and the cost to services. For example, the total estimated direct and indirect costs in Northern Ireland of overweight and obesity in 2015/6 was estimated at around £457 million, and around 18,000 hospital admissions are attributed to smoking each year in Northern Ireland.
The recently applied soft drinks industry levy (SDIL) has had a significant impact on our food
environment. Recent evidence has shown that the Levy is associated with an estimated 8% reduction in obesity rates in 10- and 11-year-old girls.
However, in Northern Ireland part of the intention of the Levy, to fund programmes to support
children’s health was not fulfilled. The revenue raised from the SDIL is received as an increase to the Block Grant, and the Department of Finance is not privy to how much the Executive receives as a result of the levy-related expenditure. It would be for an Executive to agree to the ring-fencing of such funds for spend on a particular policy, and with the institutions currently in abeyance, that ability is lost.
During previous absences of the Stormont institutions, it was reported that £12.3 million obtained from the levy in 2018/19 could not be used to target health issues due to a lack of ministers to sign- off on the policy, instead the funds were distributed pro-rata across Departments.
This example of the soft drinks industry levy illustrates how a lack of a functioning Executive and Northern Ireland Assembly contributes to a significant disadvantage in targeted policy interventions for Northern Ireland when compared to England. It is crucial that progress is made to reduce rates of overweight and obesity In Northern Ireland, as rates are continuing to increase amongst children and adults, with 65% of adults living with either overweight (38%) or obesity (27%).
With the current absence of the devolved political institutions, it has been left to the Northern
Ireland Secretary of State to set the regional rate. With the size of a business’ rates bill dependent on both the regional rate and the district rate set by councils, there is variation across Northern Ireland.
BHF have seven retail stores across Northern Ireland and therefore have a particular interest in this issue. At present, charities receive rates relief of 100%. This allows BHF to provide jobs for 26 paid employees and volunteering opportunities for around 150 volunteers in Northern Ireland.
The revenue raised through our shops has contributed to the millions of pounds invested in lifesaving research at our local universities. Our seven local shops divert 371 tonnes of unwanted goods from landfill each year. This saves local authorities thousands of pounds in waste disposal costs. In a year across all our BHF shops and stores, we save around 71,000 tonnes of goods going to waste and through the reuse and recycling of donated items, we help prevent 135,000 tonnes of CO2 emissions being released into the atmosphere. In addition, our shops act as a community hub with a positive impact on local communities through job and volunteering opportunities.
The additional potential cost burden of even an 80% mandatory rate relief for BHF NI would damage the fragile eco system in which our charity shops operate. This could result in the closure of half our Northern Ireland stores and a reduction in funding which is fundamental in enabling our work to fight the heartbreak of heart and circulatory conditions in Northern Ireland.
BHF NI believe that with knowledge of the local context across our high streets, politicians and policy makers in Northern Ireland are best placed to make decisions around any changes to rates.
April 2023